Provider Demographics
NPI:1558820779
Name:RALLIS, AUSTIN LEE (MD, PHD)
Entity Type:Individual
Prefix:
First Name:AUSTIN
Middle Name:LEE
Last Name:RALLIS
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:AUSTIN
Other - Middle Name:LEE
Other - Last Name:RENO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11 WHITEHALL RD
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03867-3226
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11 WHITEHALL RD
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03867-3226
Practice Address - Country:US
Practice Address - Phone:603-332-5211
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-18
Last Update Date:2022-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NH22738207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program